Predictors and outcomes of early left ventricular dysfunction in paediatric patients postoperative for ventricular septal defect: a retrospective cohort study based on myocardial strain and work
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Wanyu Zhao1, Weijun Li1, Tao Wang1
1Department of Ultrasound, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences/Affiliated Cardiovascular Hospital of Kunming Medical University, Yunnan Provincial Cardiovascular Clinical Medical Research Center, 528 Shahebei Road, Kunming, 650102, China.
Background:
Early postoperative left ventricular (LV) dysfunction commonly occurs after ventricular septal defect (VSD) repair in paediatric patients. This study aimed to investigate its risk factors and impact on follow-up cardiac functional status.
Methods:
We retrospectively enrolled patients with preserved LV ejection fraction (LVEF) ≥ 55% undergoing isolated surgical VSD repair. Early postoperative LV dysfunction was defined as LVEF < 55% during hospitalisation. LV function parameters including myocardial strain and work were obtained. Cardiac functional recovery was assessed at 1, 3, 6, and 12 months post-discharge based on Ross Classifications.
Results:
The cohort comprised 409 patients (3.00 [1.00-5.75] years; 50.4% male), with 82 (20.05%) developing postoperative LV dysfunction. Multivariate analysis showed that preoperative LV global longitudinal strain (LV GLS), global work index (LV GWI), global work efficiency (LV GWE), LV end-diastolic volume index (LVEDVi), moderate-to-severe sPAP, and large VSD size, as well as prolonged cardiopulmonary bypass (CPB) time, were significantly associated with postoperative LV dysfunction (all p < 0.05). ROC analyses found that integrating LV GWI and GWE with clinical parameters (LVEDVi, VSD size, or sPAP) enhanced prediction (AUC 0.848-0.883, P < 0.001). During follow-up, patients with postoperative LV dysfunction exhibited less favourable Ross classification recovery at 12 months after surgery.
Conclusions:
Myocardial strain and work indices were related to early postoperative LV dysfunction in paediatric patients after isolated VSD repair, which was correlated with persistent symptoms and cardiac dysfunction at 12-month follow-up. Pre- and postoperative LV function assessment may offer useful information for managing this patient population.
Registration:
https://www.chictr.org.cn/ ; Unique identifien ChiCTR2400092501 Retrospectively registered 18 November 2024.
